The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.
OBJECTIVE
To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.


METHODS
An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.


METHODS
Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.


METHODS
A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.


METHODS
Not applicable.


METHODS
One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.


RESULTS
After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.


CONCLUSIONS
The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.
Stineman
Margaret G
MG
Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA. mstinema@mail.med.upenn.edu
Kwong
Pui L
PL
Kurichi
Jibby E
JE
Prvu-Bettger
Janet A
JA
Vogel
W Bruce
WB
Maislin
Greg
G
Bates
Barbara E
BE
Reker
Dean M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000674:Amputees / Q000534:rehabilitation*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007297:Inpatients; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014481:United States; D014728:Veterans